CHOLECYSTECTOMY

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my operations

How I did It?

Operative Technique

Ø      Patient supine under SAB/CLEA/GA

Ø      Asepsis and antisepsis technique

Ø      Sterile drapes placed

Ø      Incision made carried from skin through subcutaneous tissue

      Midline – Fascia cut and opened through linea alba

      Kocher’s  (Right Subcostal) – Anterior rectus sheath cut and opened

                                                       Right  belly of Rectus muscle cut

                                                       Posterior Rectus sheath cut and opened

Ø      Peritoneum cut and opened

Ø      Exploration of entire abdomen carried out

Ø      Intra-operative findings noted

Ø      Retractors applied accordingly

Ø      Gallbladder identified and clamped with a Kelly at the ampulla applying traction

Ø      Triangle of Calot dissected, cutting the peritoneum that covers the area; Cystic duct identified, isolated and a temporary silk 4-0 ligature applied.

Ø      Intra-operative cholangiogram done, findings noted

Ø      Cystic artery identified, isolated, ligated and divided

Ø      Gallbladder deperitonealization done and dissected from the liver bed using electrocautery

Ø      Cystic duct divided and doubly ligated

Ø      Common bile duct palpated

Ø      Peritoneal lavage

Ø      Hemostasis

Ø      Complete sponge and instrument count

Ø      Closure layer by layer

      Peritoneum and Fascia – Vicryl 0 continuous

      Subcutaneous layer – chromic 2-0 inverted T-sutures

      Skin – silk 3-0 interrupted sutures

Ø      Betadine paint

Ø      Dry sterile dressing placed